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With today's aging population, children often find it necessary to select a nursng home for a parent. This is a job that cannot be made easy. However, if you are faced with this situation, you can be more at ease by knowing what to look for, where to find it and what to ask in the process.

Usually someone from the hospital approaches the child of an ailing parent to suggest finding a nursing home for Mom or Dad. Then they tell them, "You will have to decide on a nursing home for Mom by this Friday because the doctor feels she should be ready to be discharged by then." Hospitals discharge patients much faster than ever before and time is of the essence to the utilization review department of these hospitals. Therefore, it is best to have a plan when selecting a nursing home in a hurry.

State and government agencies have web sites containing vital information on nursing homes. You can search for these sites with some key words and terms:
*Nursing homes
*Long term care facilities
*State survey results for long term care
facilities
*Nursing home compare
*Nursing home report cards
*HCFA and nursing homes
*Nursing home publications

Some of these sites will ask for your zip code or state and county. These are sites that will be able to tell you about the nursing homes in your area. Some will be able to give you report cards on local nursing homes. They have information on the inspection results for the nursing homes you might be considering. Check these out before you go out to visit the facilities.

When you plan on visiting the nursing home, call and ask for an appointment. It is best to schedule the visit for mid afternoon when the daily care for the residents has been completed. You can also return to the nursing home, at a later time, when you are not expected. Here are some key points to observe when you get to the nursing home (Do not be afraid to make notes as you go along):

IN THE PARKING LOT: are the grounds tidy? Is there ample parking for the visitors? If the facility is in the city -- is there a problem with traffic? Are outside trash receptacles and ashtrays emptied? Remember, if they don't care about your first impression how can you be sure that they will be concerned about other things?

IN THE LOBBY: how does the receptionist greet you? Is he/she pleasant and courteous? How is he/she dressed? Is the lobby clean? Is there a mat to prevent slipping in wet weather? Are there handwritten notes taped-up all over the area? Do you detect any odors? How long are you kept waiting for the tour? If other employees are in the lobby -- are they noisy?

DURING THE TOUR: Take you time and don't allow the facility's representative to rush you through the facility. As you walk slowly, observe the following things:
-Are the residents dressed appropriately? Do chair bound residents have shoes and/or socks? Is their clothing mismatched, stained or in disarray? Are they neatly groomed?
-Do you detect any offensive odors? (Some odors cannot be avoided in a nursing home. However, there should not be stale odors or smells that linger for a long time.)
-Are the lounges supervised? Are there any activities going on in the resident lounges? Look at the furnishings -- are they in good condition? Ask for a copy of the monthly activity calendar.
-Ask to use the bathroom. Is it clean and odor free? Look for paper towels, bathroom tissue and soap.
-Ask to see the resident's bath/shower room. Would you mind taking a shower there? Is it clean? Do you note any soiled linen, towels or clothing on the floor, chairs etc? Is there an odor?
-Smile or say hello to some of the employees and note how they respond to your greeting.
-Observe the manner in which the staff addresses the residents. Is there interaction between the employees and residents? Are privacy curtains used during care? Do you see the staff treating the residents with dignity?
-Tell them you would like to see a resident room. Will the space accommadate your loved one's needs? Are the windows clean? Are there bathroom facilities for each room? Is the room and bathroom neat and clean? Is it too hot -- too cold? (Remember, older adults often feel cold.)
-Note the noise level. Are there patient/residents hollering-out for assistance? Do you hear/see staff chattering loudly in resident areas?
VERY IMPORTANT! OBSERVE THE LENGTH OF TIME IT TAKES THE STAFF TO ANSWER CALL-LIGHTS. The lights over resident's doors are used to alert the nursing staff that a resident is in need of assistance. Are those call-lights on for long periods of time without being answered? Was there a call-light on for the entire length of your tour?

THERE ARE IMPORTANT QUESTIONS YOU SHOULD ASK. ADD THESE QUESTIONS TO ANY OTHER QUESTIONS YOU NEED ANSWERED:
-Ask to see a copy of the nursing home's most recent survey results. (This is what is written following an inspection.) Take the time to read it carefully. If you don't understand something--ask a question or write it down and ask someone you know when you get home.
-Are the visiting hours limited?
-What is the smoking policy?
-Does the facility have a policy on how they respond to family/resident's concerns or complaints? What is that policy?
-What is their policy on lost glasses or dentures? What about lost clothing or personal belongings?
-How is the personal laundry handled? (What if family will do the laundry?)
-Are residents permitted to personalize their rooms with small furnishings from home?
-How often does the facility move residents from one room to another? What is the policy for moving residents?
-What is the nursing home's policy on physical and chemical restraints?
-Is the nursing home well staffed -- or do they use a high number of outside agency (temporary) nursing staff? What is the ratio of nurses to residents?
-Ask about issues directly related to your parent's needs or likes, "My mother enjoys a cup of tea in the afternoon before her nap -- can she have her tea here?" Or, "My father smokes his pipe each evening after dinner. Will he be able to do that here at your facility?"
-Inquire if there is a safe place outdoors where residents can enjoy the nice weather. (This is sometimes a problem -- especially in the intercity faciities)
-Are there outings scheduled regularly? Get a copy of the schedule.

There is no exact science or formula for selecting the perfect nursing home. However, there are many resources to get assistance in making a decision. In addition, this article can guide you with making observations and asking questions that are important when you are faced with making a choice.